American Journal of Health Promotion

To describe the development of the first disease prevention intervention with ultra-Orthodox Jewish (UOJ) women in Israel using mixed methods and community-based participatory research (CBPR).

This collaborative, 7-staged development process used an exploratory sequential mixed methods design integrated into a community-based participatory approach.

The UOJ community in Israel, a high-risk, low socioeconomic, culturally insular minority that practices strict adherence to religious standards, maintains determined seclusion from mainstream culture and preserves traditional practices including extreme modesty and separation between the sexes.

Women from a targeted UOJ community in Israel with distinct geographic, religious, and cultural parameters. These included 5 key informant interviewees, 5 focus groups with 6 to 8 participants in each, a cluster randomized sample of 239 questionnaire respondents (an 87% response rate), and 11 steering committee participants.

Qualitative data were analyzed through Interpretative Phenomenological Analysis by 2 researchers. Quantitative data were collected via questionnaire (designed based on qualitative findings) and analyzed utilizing descriptive statistics.

Barriers to health behavior engagement and intervention preferences were identified. The final intervention included walking programs, health newsletters, community leader trainings, teacher and student trainings, and health integration into schools.

Utilizing mixed methods in CBPR improved cultural tailoring, potentially serving as a model for intervention design in other difficult to access, low socioeconomic, and culturally insular populations.

To estimate the relationship between employees’ health risks and health-care costs to inform health promotion program design.

An observational study of person-level health-care claims and health risk assessment (HRA) data that used regression models to estimate the relationship between 10 modifiable risk factors and subsequent year 1 health-care costs.

United States.

The sample included active, full-time, adult employees continuously enrolled in employer-sponsored health insurance plans contributing to IBM MarketScan Research Databases who completed an HRA. Study criteria were met by 135 219 employees from 11 employers.

Ten modifiable risk factors and individual sociodemographic and health characteristics were included in the models as independent variables. Five settings of health-care costs were outcomes in addition to total expenditures.

After building the analytic file, we estimated generalized linear models and conducted postestimation bootstrapping.

Health-care costs were significantly higher for employees at higher risk for blood glucose, obesity, stress, depression, and physical inactivity (all at P < .0001) than for those at lower risk. Similar cost differentials were found when specific health-care services were examined.

Employers may achieve cost savings in the short run by implementing comprehensive health promotion programs that focus on decreasing multiple health risks.

To evaluate the effect of a 17-week intervention, including an after-school physical activity (PA) club 3 d/wk, on moderate-to-vigorous physical activity (MVPA), body mass index (BMI) z score, percentage body fat (%BF), and cardiorespiratory fitness (CRF) among fifth to eighth grade girls having a BMI z score ≥0, and explore whether intervention outcomes varied by club attendance (1 vs 2 vs 3 d/wk).

Secondary analysis of data from a group randomized controlled trial (N = 1519, 10- to 15-year-old girls: n = 753 intervention; n = 766 control).

Twenty-four Midwestern US schools (n = 12 intervention; n = 12 control).

Subsample (n = 1194 girls) from trial’s intervention (n = 593 girls) and control (n = 601 girls) groups having BMI z scores ≥0.

Moderate-to-vigorous physical activity (min/h), BMI z score, %BF, and CRF ( V ˙ O 2max : mL/kg/min) were estimated at baseline and postintervention.

Linear mixed-effect models.

Intervention group gained less %BF (B = −0.35, P = .016), and their CRF decreased less (B = 0.22, P = .010) than the control. Marginally significant findings showed girls attending the club an average of 1 d/wk had greater increases in %BF (B = 0.33, P = .087) and MVPA (B = 0.20, P = .083) and a greater decrease in CRF (B = −0.20, P = .061) than girls attending 3 d/wk. No differences occurred between girls who attended 2 versus 3 d/wk for any outcomes.

The intervention attenuated an increase in %BF and a decrease in CRF among girls at risk for obesity from baseline to postintervention. Offering the after-school PA club 2 d/wk may be adequate for achieving outcomes.

To compare the degree to which youth with and without chronic conditions in the United States met physical activity (PA), screen time, and sleep duration guidelines.

A cross-sectional study using data from the 2016 National Survey of Children’s Health.

A total of 24 405 youth (aged 10-17 years) with and without 1 of 19 prevalent chronic health conditions who participated in the 2016 National Survey of Children’s Health.

Parents reported on the time spent by their children in PA, screen time, and sleep.

Descriptive and bivariate analyses were conducted to estimate and compare health behavior guideline adherence rates among children with and without chronic conditions.

Overall, 18.7% of children with chronic conditions did not meet any health behavior guidelines compared to 15.6% of children without chronic conditions. Children with hearing impairments, diabetes, and depression were most likely to not meet any health behavior guidelines (27.9%, 25.4%, and 21.7%, respectively). Of the 3 guidelines, children with and without chronic conditions were least likely to meet the PA guideline (18.6% and 21%, respectively).

This study identifies specific groups of children with chronic conditions that are most at risk of not meeting health behavior guidelines. The findings highlight specific behaviors in most need of intervention for children with chronic conditions; PA was identified as the most frequently unmet guideline. Overall findings suggest a need for a more integrated, holistic view of health promotion for children with chronic conditions.

To measure implementation outcomes of a freely available workplace health promotion program (Healthier Workplace Western Australia [HWWA]) that provides employees with services and supports to make changes in their workplaces.

Western Australian workplaces.

Employees accessing HWWA services.

A range of services (training sessions, tailored advice, grant schemes, online resources) were offered relating to nutrition, physical activity, smoking, alcohol consumption, and mental health.

Of the 1627 individuals e-mailed 6 months after participation in HWWA, 345 (21%) individuals who recalled accessing one or more services completed a survey assessing the number and type of changes they had implemented and the perceived barriers to doing so.

Negative binomial regressions and one-way analysis of variances assessed whether respondent characteristics or number of services used was associated with the number and types of changes made. A qualitative analysis of the perceived barriers was also conducted.

The majority of respondents (86%) reported implementing one or more changes. Greater perceived responsibility/authority to make change (β = .56, P < .01), perceived support from coworkers (β = .23, P < .05), and number of HWWA services used (β = .04, P < .05) were positive predictors of the number of changes made. Frequently reported barriers included cost/budget restrictions, lack of management support, and resistance from staff.

The HWWA program facilitated implementation of various healthy workplace initiatives across the organizations represented in the evaluation.

This systematic review and meta-analysis examined the effects of exercise on individuals with alcohol use disorders (AUDs) across multiple health outcomes.

PubMed, Medline, Web of Science, Scopus, Academic Search complete, Sport Discuss, and ERIC databases.

Interventional studies published between 2000 and 2018 focused on evaluating the effectiveness of exercise interventions in adults with AUD.

This protocol was prepared using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols standard and the Meta-Analyses and Systematic Reviews of Observational Studies guidelines.

Physical activity levels/fitness [VO₂ max (Oxygen Uptake) and HRmax (Maximum Heart Rate)], levels of depression, anxiety, self-efficacy, quality of life, and alcohol consumption (number of standard drinks consumed per day and per week).

The findings indicated that exercise significantly improved physical fitness as assessed by VO₂ max (standardized mean difference [SMD]: 0.487, P < .05) and HRmax (SMD: 0.717, P < .05). Similarly, exercise significantly improved mental health as assessed by quality of life (SMD: 0.425, P < .05), but levels of depression, anxiety, self-efficacy, and alcohol consumption did not change significantly. Aerobic exercise alleviated depression and anxiety symptoms more than that of yoga and mixed types. Duration of exercise also had a similar effect on anxiety and depression.

Exercise can be an effective and persistent adjunctive treatment for individuals with AUDs.

To identify and describe behavioral interventions to promote sexual and reproductive health among US active duty military service members.

Systematic searches of PubMed, CINAHL, and PsychINFO (N = 1609 records).

English-language articles published between 1991 and 2018 and retrieved using search terms related to military service, interventions, and sexual and reproductive health.

Articles excluded if not empirically based, not published in peer-reviewed journals, did not sample active duty US military personnel, and did not examine the effectiveness of specified preventive sexual or reproductive health intervention(s).

Teams of paired authors extracted study rationale; aims; design; setting; description of the intervention; measures; sample demographics; clinical, behavioral, and psychosocial outcomes; and conclusions.

Given the heterogeneity of studies, narrative synthesis was performed.

Fifteen articles met inclusion criteria: 10 focused on sexually transmitted infection (STI) acquisition and/or unintended pregnancy and 5 on sexual assault. Studies that assessed clinical outcomes found that interventions were associated with lower rates of STIs and/or unintended pregnancy. Significant effects were found on knowledge-related outcomes, while mixed effects were found on attitudes, intentions, and behaviors.

Current evidence on the effectiveness of sexual and reproductive health interventions in the US military is limited in quality and scope. Promoting sexual and reproductive health in this population is critical to maintaining well-being among servicemembers, their families, and the communities surrounding military installations.

To examine factors associated with frequency of plain water (ie, tap, bottled, and unflavored sparkling water) intake among US high school students.

Quantitative, cross-sectional study.

The 2017 national Youth Risk Behavior Survey data.

US high school students with plain water intake data (N = 10 698).

The outcome was plain water intake. Exposure variables were demographics, academic grades, and behavioral characteristics.

We used logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CIs) for factors associated with infrequent plain water intake (<3 vs ≥3 times/day).

Overall, 48.7% of high school students reported drinking plain water <3 times/day. Factors associated with infrequent plain water intake were younger age (≤15 years; aOR = 1.20, CI = 1.05-1.37); earning mostly D/F grades (aOR = 1.37, CI = 1.07-1.77); consuming regular soda 1 to 6 times/week (aOR = 1.92, CI = 1.67-2.20) or ≥1 time/day (aOR = 3.23, CI = 2.65-3.94), sports drinks 1 to 6 times/week (aOR = 1.30, CI = 1.14-1.49), milk <2 glasses/day (aOR = 1.51, CI = 1.31-1.73), fruits <2 times/day (aOR = 1.92, CI = 1.66-2.22), and vegetables <3 times/day (aOR = 2.42, CI = 2.04-2.89); and being physically active ≥60 minutes/day on <5 days/week (aOR = 1.83, CI = 1.60-2.08). Students with obesity were less likely to have infrequent water intake (aOR = 0.63, CI = 0.53-0.74).

Infrequent plain water intake was associated with younger age, poor academic grades, poor dietary behaviors, and physical inactivity. These findings can inform intervention efforts to increase water intake to promote healthy lifestyles among adolescents.

To assess if exposure to the Choose Water public health media campaign increased parents’ intentions to promote healthier beverage consumption in their household.

A cross-sectional evaluation administered post-campaign.

A 2017 internet panel survey in Los Angeles County, California.

The survey included 499 parents of young children.

The Choose Water media campaign included digital media and out-of-home advertisements (eg, transit shelters, interiors of buses) in both English and Spanish.

Dichotomous outcome variables were parental intentions to give child(ren) (1) more water and (2) less sugar-sweetened beverage consumption in their households. The independent variable was campaign exposure, categorized as no exposure, exposed but did not discuss visual, and exposed and discussed visual with someone.

Descriptive, bivariate, and multivariable logistic regressions.

Among those who were exposed and discussed a campaign visual, the adjusted odds of intending to promote water consumption were 2.82 times greater than for those who reported no exposure (95% confidence interval [CI]: 1.46-5.46). Similar odds to promote less sugar-sweetened beverage consumption were observed for those who were exposed and discussed a campaign visual (adjusted odds ratio: 3.27, 95% CI: 1.76-6.08). Those with the lowest educational attainment discussed the visual(s) less (10.5%).

Word of mouth may enhance health messaging by allowing time for intended audiences to process campaign content within their interpersonal network.

This study examines the association between nonparticipation in wellness activities and employee turnover risk.

Retrospective, cross-sectional analysis.

Large university in the Midwestern United States.

Employees with continuous employment during 2016 and complete human resources and wellness program data (n = 34 405).

Demographic, health risk assessment (HRA), and wellness program participation data were collected in 2016 and paired with administratively recorded turnover status from 2017. For the multivariate analyses, logistic regression models were used.

There were statistically significant associations between various socioeconomic and demographic characteristics (gender, age, race, wage, union and faculty status, and health score) with turnover status. Also, all 3 participation levels (participated in the HRA only, participated in the HRA and wellness programming, and participated in wellness programming only) had lower odds of experiencing turnover compared to nonparticipants (participated in the HRA only [adjusted odds ratio, AOR: 0.89; confidence interval, CI: 0.80-0.99], participated in wellness program(s) only [AOR: 0.77; CI: 0.62-0.95] and participated in both the HRA and program(s) [AOR: 0.82; CI: 0.74-0.91], respectively).

Employee participation in wellness program activities appears to represent a measure of engagement with work. Nonparticipation in these programs is associated with increased risk of employment turnover in the subsequent year.